Difference Of Clinical Efficacy And Effect Mechanism Between Acupuncture And Moxibustion In The Prevention And Treatment Of Inflammatory Bowel Disease

Objective:To investigate the differences in clinical efficacy and related mechanisms between acupuncture and moxibustion.They were performed on patients with IBD,and their clinical outcomes and differences were observed after treatment.To initially reveal the intervention effects and mechanism differences between acupuncture and moxibustion in IBD mice.By investigating the differences in the efficacy and characteristics of the two methods,it can provide a reference and basis for the selection of clinical treatment methods.Methods:1.Ninety patients with IBD who met the inclusion criteria were randomly divided into the acupuncture group,the moxibustion group,and the positive drug group.Patients in the acupuncture group and the moxibustion group were selected for treatment at the ST25（bilateral）and the ST36（bilateral）and were treated once a day for 20 minutes for 2 weeks.The positive drug group gave patients mesalazine enteric tablets for oral administration.At the end of treatment,the clinical efficacy of IBD patients in each group was observed,using the efficacy evaluation rating scale as the primary outcome index and the TCM symptom score as the secondary outcome index,and the impact on the overall quality of life of patients was evaluated by the Inflammatory Bowel Disease Quality of Life Questionnaire（IBDQ）.2.Sixty C57/BL6 mice were divided into control group,model group,acupuncture group,moxibustion group,and positive drug group.The mice in the control group drank water normally,and the model group,acupuncture group,moxibustion group,and positive drug group drank 0.75%concentration of Dextran Sulfate Sodium aqueous solution to replicate the IBD model.The control and model groups were not intervened.The acupuncture and moxibustion groups were selected to intervene in mice with ST25（bilateral）and the ST36（bilateral）once a day for 15 minutes for 2 weeks.The positive drug group was given mesalazine(200 mg·kg^-1)by gavage once a day for 2 weeks.The mice were observed for general conditions（body weight,food and water intake,activity,responsiveness,defecation characteristics）,colonic tissue morphology,Hematoxylin-Eosin（HE）staining for colonic pathological changes,and Enzyme-linked immunosorbent assay（ELISA）for detection of inflammatory factors（TNF-α,NF-κB,IL-1β,IL-17,IL-6,IL-10）in blood and colon tissues,which is to clarify the intervention effects of acupuncture and moxibustion on IBD mice;the intestinal flora in the feces of each group of mice were analyzed by 16S r DNA technique to find the key flora of the effects of acupuncture and moxibustion.The metabolomics of mouse feces was examined by GC-MS and LC-MS techniques to screen the differential metabolites and metabolic pathways between the effects of acupuncture and moxibustion,and to investigate the differences and mechanisms of the effects of acupuncture and moxibustion on mice with IBD.Results:1.Clinical efficacy of acupuncture and moxibustion on patients with IBD:（1）Total treatment efficiency:81.48%in the acupuncture group and 82.14%in the moxibustion group.There was no statistical difference in the total effective rate of treatment between the two groups（P>0.05）.（2）TCM symptom scores:The TCM symptom scores of patients in the acupuncture and moxibustion groups were significantly lower after 2 weeks of treatment（P<0.001）.The total TCM symptom scores did not show significant differences between the groups of acupuncture and moxibustion（P>0.05）,but the two reflected different modulating abilities in a single symptom.There was a statistically significant difference in TCM symptom scores for abdominal pain after acupuncture treatment（P<0.001）and for more bowel sounds and cold feeling after moxibustion treatment（P<0.001）.（3）Quality of life scale scores of inflammatory bowel disease:there was a significant difference between the quality of life scale scores after acupuncture and moxibustion treatment（P<0.05）,and there was no significant difference between the two groups of acupuncture and moxibustion.2.Experimental studies of acupuncture and moxibustion on IBD mice:（1）After the intervention of acupuncture and moxibustion,the body weight of both mice increased,which was statistically significant relative to the model group（P<0.05）;the degree of damage to colon tissue was reduced,and inflammatory factors in blood and intestinal tissue（TNF-α,NF-κB,IL-1β,IL-17,IL-6,IL-10）were all regulated toward the control group.（2）Both the two methods could regulate the dysbiosis in IBD mice,but the two had different effects on the structural composition of the flora and differential bacteria in IBD mice.At the genus level,there were 19 shared differential bacteria,14 differential bacteria specific to acupuncture and 3 differential bacteria specific to moxibustion.（3）The two methods can regulate metabolic disorders in IBD mice,but they involve different pathways.There were16 shared pathways,mostly related to inflammation,energy metabolism,and amino acid metabolism.Acupuncture specifically regulates arginine biosynthesis,and moxibustion specifically regulates retrograde endogenous cannabinoid signaling,ovarian steroidogenesis,alanine,aspartate and glutamate metabolism,and other pathways related to amino acid metabolism,neural signaling,energy metabolism,and anti-inflammation.Conclusions:1.Both acupuncture and moxibustion were effective in patients with IBD,and they did not show significant differences in overall efficacy;however,they showed different modulating ability in single symptoms,with acupuncture being more effective in relieving abdominal pain and moxibustion being more effective in modulating more bowel sounds and cold feeling.2.Both acupuncture and moxibustion can improve the pathological status of IBD mice,reduce intestinal mucosal damage,regulate the abnormal expression of inflammatory factors,improve the imbalance of intestinal flora,and regulate metabolic disorders.However,the regulation of intestinal flora composition and different genera of bacteria are different between the two groups.They can regulate metabolites and metabolic pathways in IBD mice,but moxibustion has a broader regulation of amino acid metabolism,neural signaling,energy metabolism,and anti-inflammatory-related pathways.